Resistance to Treatment in Eating Disorders: a new article collection for BMC Psychiatry

Edited by SecondoFassino, Section Editor for BMC Psychiatry, this special issue presents a collection of articles that focus on treatment resistance in eating disorders, a growing concern in psychiatric clinical practice and one that affects a broad range of disorders from anorexia to obesity.

Eating disorders are characteristically difficult to treat mental illnesses, in which effective evidence-based treatments are currently lacking. The articles in this collection aim to encourage more research in the area and to stimulate discussion on this complex, and sometimes controversial, subject.

Clinical practice and psychological aspects

Some of the articles in the series focus on the psychological aspects of treatment resistance that could have consequences for clinical practice. A systematic review by Abbate-Daga and colleagues identifies four areas linked to treatment resistance: denial, motivation to change, therapeutic relationships, and maintaining factors and treatment outcome. Other research articles emphasise the importance of familial and carer relationships, reducing drop-out rates in treatment programs and the link between personality-type and poor treatment outcome.

Psychopathology and associated disorders

Katherine Halmi reviews the importance of severity of the core eating disorder in predicting resistance to treatment, discussing possible ways to develop more successful interventions. Eating disorder co-morbidities with other axis 1 and substance use disorders are also investigated. Preliminary evidence linking childhood ADHD with obesity is presented, paving the way for further research in this area, whilst emotive and perceptual components of eating disorders are also examined, providing further insight into the causes of treatment resistance.

Practical measures and treatment

Other articles in the collection stress the need for a comprehensive multidimensional evaluation during treatment in order to monitor progress and reduce resistance. Mitchison and colleagues test the applicability of a health-related quality of life assessment specifically adapted to eating disorders, whilstMander et al. report that assessing stages of change with standardised maintenance instruments might help identify patients at relapse risk.

A reflective review from Marzola and colleagues details the need for evidence based data on nutritional restoration in Anorexia Nervosa (AN). And finally, preliminary data on the use of Dialectical Behavioural Therapy as treatment for AN are presented with hopeful results, encouraging further research.

"A critical challenge"

In an insightful editorial, Fassino and Abbate-Daga consider the critical challenge faced by treatment resistance in eating disorders within psychiatric clinical practice.

An explicative model of treatment resistance is presented which incorporates both environmental and genetic factors associated with eating disorders. The authors conclude by highlighting the need for more research into biological features, therapeutic relationships, and emotional responses in individuals and their families.